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A Case of Left Ventricular Endoventricular Patch Plasty for Severe Heart Failure Induced by Ischemic Cardiomyopathy
The 20th Annual Scientific Meeting acute coronary syndrome, we performed cardiac catheterization. Coronary angiography showed no organic stenosis and biopsy from right ventricle (RV) revealed eosinophilia infiltration. We diagnosed as eosinophilic myocarditis and started 50 mg predonisolone daily. LV wall motion improved gradually (LVEF 40%), and we tapered the dosage to 5 mg daily and continued. After 5 years from the first diagnosis, he felt dyspnea and transferred to our hospital. Chest X-ray showed pulmonary congestion and bilateral pleural effusion. TTE showed LV wall motion abnormalities and moderate pericardial effusion. Blood sample showed increase of eosinophilia by 2.90 × 1000/ul. We performed RV biopsy, and revealed eosinophlia infiltration. We diagnosed as a recurrence of eosinophilic myocarditis and increased predonisolone from 5 to 50 mg daily. After increase of predonisolone for 2 weeks, LV wall motion improved (LVEF from 40% to 48%) and pericardial effusion was disappeared resulting in the improvement of heart failure. Recurrence of eosinophilic myocarditis is a rare case, and we want to report this case with the literature review of recurrent myocarditis.
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Brochenbrough phenomenon. This patient was diagnosed as having HOCM and VSA. Diltiazem was prescribed and she had been followed by her family doctor. Two years later, she could not walk for a short distance and was admitted to our institution. At admission, she took some medications, such as diltiazem, telmisartan and diuretics. Blood chemical data showed the elevation of BNP (769 pg/mL). Echocardiography (UCG) showed the significant pressure gradient through left ventricle outflow tract (LVOT, 159 mmHg) at rest. We judged the worsening status of HOCM and prescribed cibenzoline with 150 mg, but pressure gradient did not changed. We stopped the diuretics and changed from diltiazem to verapamil. Thereafter, her symptoms improved and the pressure gradient though LVOT reduced and she was discharged. Several cardiovascular medications may affect the status of HOCM and the cardiologists should be careful in selection of such drugs in patients with HOCM.
P7-3 P6-6 A Case of Fulminant Myocarditis Fully Recovered After Four Weeks PCPS Support Takashi Suzuki, Emi Mori, Akiko Nakazawa, Rikako Koizumi; Cardiovascular Center, Kin-Ikyo Chuo Hospital, Sapporo, Japan A 20-year-old female was admitted to our hospital with chief complaints of pre syncope and fever. On the second hospital day, chest pain appeared and ST segments were elevated. Due to her symptoms, we performed an emergent cardiac catheter procedure. It showed coronary arteries were normal. Then, we performed a myocardium biopsy. After those procedures, she was under ICU care. However, she went in shock on that day. She was diagnosed with fulminant myocarditis. PCPS, IABP and Ventilator were attached, and TPM was also inserted. At that time, LVEF was less than 10%. PCPS weaning failed on the 18th hospital day. We realized that the patient depended on ventricular pacing. We implanted a DDD pacemaker to improve her hemodynamics on the 25th hospital day. On 29th hospital day, PCPS weaning was successfully done. Three months after admission, her cardiac function was improved to 50% of LVEF. However, she still required long physical rehabilitation because of ossifying myositis. Seven months since she admitted to hospital, she discharged from our hospital on foot and fully recovered. We experienced a case of fulminant myocarditis patient who fully recovered from long term assisted circulation device use.
P7-1 Acute Ischemia Due to Coronary Spastic Angina Exaggerated Mitral Regurgitation in a Patient With Dilated-Phase Hypertrophic Cardiomyopathy Chiharuko Iio1, Haruhiko Higashi1, Kazuhisa Nishimura1, Yuta Watanabe1, Hironori Izutani2, Takafumi Okura1, Jitsuo Higaki1, Shuntaro Ikeda1; 1Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan; 2Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
Short Bowel Syndrome With Congestive Heart Failure due to Ischemic Heart Disease—A Case Report Kazuhisa Kaneda, Akihiro Kushiyama, Masashi Kato, Takafumi Yokomatsu, Shinji Miki; Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan Short bowel syndrome (SBS) is group of problems related to poor absorption of nutrients. It can be occurred in patients who have at least half of their small intestine removed due to mesenteric artery thrombosis, Crohn’s disease and so on. Heart failure with atrial fibrillation or arteriosclerosis can cause SBS due to mesenteric artery thrombosis and there is a difficulty for evaluating the absorption of drugs or nutrients. However, the therapeutic management of heart failure for such patients has’t been shown well. A case is 75-year-old woman who had chronic atrial fibrillation without anticoagulant. She was diagnosed intestinal necrosis due to superior mesenteric artery thrombosis, and had resection of extensive small bowel and right half colon. Consequently, 20 cm of small bowel was remained. 60 days after surgery, she was consulted to cardiovascular department for heart failure with reduced cardiac ejection fraction. We treated congestive heart failure with intra venous Acetazolamide and Carperitide, and found coronary artery stenosis by cardiac computedtomographic angiography. We performed percutaneous transluminal coronary angioplasty with drug-eluting stent. The patient discharged on day 157 to home after suitable nutritional management, rehabilitation, wound treatment and drug treatment with dual antiplatelet therapy (Aspirin and Clopidogrel), anticoagulant (Walfarin) and diuretic. The clinical course is benign for 3 months without recurrence of heart failure or stent thrombosis.
P7-4 A Case of Left Ventricular Endoventricular Patch Plasty for Severe Heart Failure Induced by Ischemic Cardiomyopathy Eiji Miyauchi, Atsuko Hiramine, Ryo Arikawa, Yusuke Kamizono, Masahiro Kamekou; Cardiovascular Medicine, Kanoya Medical Center, Kagoshima, Japan
A 53 year-old woman who had a history of dilated-phase hypertrophic cardiomyopathy (d-HCM) was admitted to our emergency room presenting with shock vital. Her electrocardiogram showed a lead aVR ST-segment elevation with wide spread ST depression, indicating broad myocardial ischemia. Echocardiography revealed severe mitral regurgitation (MR) due to tethering of posterior mitral leaflet. After initiation of intra-aortic balloon pumping (IABP), coronary angiography and left ventriculography were performed. Her coronary arteries had no significant stenosis, and left ventriculography showed massive MR, confirming echocardiographic finding. Evaluation by right-sided heart catheterization showed severe heart failure. Even after heart failure treatment, she had repeated chest pain and dyspnea through the night. Magnetic resonance imaging demonstrated the additional late gadolinium enhancement in the subendocardial lesion of right coronary artery (RCA) area, suggesting myocardial damage at this territory. Acetylcholine provocation test was performed to investigate the relation between coronary spasm and myocardial damage. A 50 μg acetylcholine infusion induced obstruction of the distal portion of RCA. Her chest pain accompanied by ST-T change was also appeared. We thus diagnosed coronary spasm exacerbate the tethering of posterior leaflet and worsened MR. Early mitral valve replacement was required for recovery from refractory heart failure. We herewith report that acute ischemia due to coronary spasm could be a major cause of worsening of MR in a patient with d-HCM.
Introduction: The increase in LV volume after myocardial infarction, a representational form of the remodeling process, result in severe cardiac dysfunction. LV endoventricular patch plasty is a surgical treatment to restore heart geometry and finally to improve cardiac function. Case: Five years ago, 63-year-old man developed acute broad anterior myocardial infarction (peak CPK 10188 IU/L). Although optimal medical therapy was introduced, he was repeatedly hospitalized because of heart failure. During this admission, he got dependent on catecholamine treatment. Echocardiogram showed severe left ventricular dysfunction localized in antero-septal wall with severe aortic regurgitation and mitral regurgitation. One year ago, LV endoventricular patch plasty: modified Dor, with aortic valve replacement and mitral valve plasty were performed. After the operation, LV volume reduced effectively and cardiac function improved. He could discharge to home after discontinuation of catecholamine treatment and reduction of diuretics dose. He has remained under stable conditions for this one year. Discussion: LV endoventricular patch plasty is one of the effective surgical treatments to treat severe heart failure. However, in some cases who have little residual cardiac muscle, the effectiveness cannot be expected. Moreover, LV endoventricular patch plasty has a high risk because the candidate is suffering poor conditions. Therefore, we should carefully consider the operative indication of LV endoventricular patch plasty and its limitations.
P7-2
P7-5
A Case of Hypertrophic Obstructive Cardiomyopathy and Vasospastic Angina, in Which Controlling Medical Treatment was in Great Distress Hiroki Teragawa, Yuichi Fujii, Yuko Uchimura, Tomohiro Ueda; The Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
A Case of Difficult in the Treatment of Heart Failure After Acute Myocardial Infarction of the Left Main Coronary Artery Yoji Tamaki, Yoshihiro Masaki, Taro Koya, Toshihiro Shimizu, Takayuki Hirabayashi; Cardiovascular Medicine, Sunagawa City Medical Center, Hokkaido, Japan
Vasospastic angina (VSA) is accompanied with hypertrophic obstructive cardiomyopathy (HOCM). In such patients, controlling medical treatment may be sometimes difficult, because some drugs for VSA may deteriorate the status of HOCM. We experience such case. A woman in her seventies, was admitted to our institution, because of detail examination of chest symptoms at rest. Coronary angiography showed the presence of coronary spasm. In addition, cardiac catheterization showed that the positive
A 70-year-old male had chest pain and in a shock status, was received an emergency catheterization with intra aortic balloon pumping. He had developed an acute myocardial infarction of the left main coronary artery, then percutaneous coronary intervention was done. Because infarct size were large, peak CPK was 9673 IU/L and and peak CK-MB was 690 ng/ml with high value. Congestive heart failure (CHF) was worsened after admission to intensive care unit, so mechanical ventilation was performed.
•
JHFS
S221
Brochenbrough phenomenon. This patient was diagnosed as having HOCM and VSA. Diltiazem was prescribed and she had been followed by her family doctor. Two years later, she could not walk for a short distance and was admitted to our institution. At admission, she took some medications, such as diltiazem, telmisartan and diuretics. Blood chemical data showed the elevation of BNP (769 pg/mL). Echocardiography (UCG) showed the significant pressure gradient through left ventricle outflow tract (LVOT, 159 mmHg) at rest. We judged the worsening status of HOCM and prescribed cibenzoline with 150 mg, but pressure gradient did not changed. We stopped the diuretics and changed from diltiazem to verapamil. Thereafter, her symptoms improved and the pressure gradient though LVOT reduced and she was discharged. Several cardiovascular medications may affect the status of HOCM and the cardiologists should be careful in selection of such drugs in patients with HOCM.
P7-3 P6-6 A Case of Fulminant Myocarditis Fully Recovered After Four Weeks PCPS Support Takashi Suzuki, Emi Mori, Akiko Nakazawa, Rikako Koizumi; Cardiovascular Center, Kin-Ikyo Chuo Hospital, Sapporo, Japan A 20-year-old female was admitted to our hospital with chief complaints of pre syncope and fever. On the second hospital day, chest pain appeared and ST segments were elevated. Due to her symptoms, we performed an emergent cardiac catheter procedure. It showed coronary arteries were normal. Then, we performed a myocardium biopsy. After those procedures, she was under ICU care. However, she went in shock on that day. She was diagnosed with fulminant myocarditis. PCPS, IABP and Ventilator were attached, and TPM was also inserted. At that time, LVEF was less than 10%. PCPS weaning failed on the 18th hospital day. We realized that the patient depended on ventricular pacing. We implanted a DDD pacemaker to improve her hemodynamics on the 25th hospital day. On 29th hospital day, PCPS weaning was successfully done. Three months after admission, her cardiac function was improved to 50% of LVEF. However, she still required long physical rehabilitation because of ossifying myositis. Seven months since she admitted to hospital, she discharged from our hospital on foot and fully recovered. We experienced a case of fulminant myocarditis patient who fully recovered from long term assisted circulation device use.
P7-1 Acute Ischemia Due to Coronary Spastic Angina Exaggerated Mitral Regurgitation in a Patient With Dilated-Phase Hypertrophic Cardiomyopathy Chiharuko Iio1, Haruhiko Higashi1, Kazuhisa Nishimura1, Yuta Watanabe1, Hironori Izutani2, Takafumi Okura1, Jitsuo Higaki1, Shuntaro Ikeda1; 1Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan; 2Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
Short Bowel Syndrome With Congestive Heart Failure due to Ischemic Heart Disease—A Case Report Kazuhisa Kaneda, Akihiro Kushiyama, Masashi Kato, Takafumi Yokomatsu, Shinji Miki; Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan Short bowel syndrome (SBS) is group of problems related to poor absorption of nutrients. It can be occurred in patients who have at least half of their small intestine removed due to mesenteric artery thrombosis, Crohn’s disease and so on. Heart failure with atrial fibrillation or arteriosclerosis can cause SBS due to mesenteric artery thrombosis and there is a difficulty for evaluating the absorption of drugs or nutrients. However, the therapeutic management of heart failure for such patients has’t been shown well. A case is 75-year-old woman who had chronic atrial fibrillation without anticoagulant. She was diagnosed intestinal necrosis due to superior mesenteric artery thrombosis, and had resection of extensive small bowel and right half colon. Consequently, 20 cm of small bowel was remained. 60 days after surgery, she was consulted to cardiovascular department for heart failure with reduced cardiac ejection fraction. We treated congestive heart failure with intra venous Acetazolamide and Carperitide, and found coronary artery stenosis by cardiac computedtomographic angiography. We performed percutaneous transluminal coronary angioplasty with drug-eluting stent. The patient discharged on day 157 to home after suitable nutritional management, rehabilitation, wound treatment and drug treatment with dual antiplatelet therapy (Aspirin and Clopidogrel), anticoagulant (Walfarin) and diuretic. The clinical course is benign for 3 months without recurrence of heart failure or stent thrombosis.
P7-4 A Case of Left Ventricular Endoventricular Patch Plasty for Severe Heart Failure Induced by Ischemic Cardiomyopathy Eiji Miyauchi, Atsuko Hiramine, Ryo Arikawa, Yusuke Kamizono, Masahiro Kamekou; Cardiovascular Medicine, Kanoya Medical Center, Kagoshima, Japan
A 53 year-old woman who had a history of dilated-phase hypertrophic cardiomyopathy (d-HCM) was admitted to our emergency room presenting with shock vital. Her electrocardiogram showed a lead aVR ST-segment elevation with wide spread ST depression, indicating broad myocardial ischemia. Echocardiography revealed severe mitral regurgitation (MR) due to tethering of posterior mitral leaflet. After initiation of intra-aortic balloon pumping (IABP), coronary angiography and left ventriculography were performed. Her coronary arteries had no significant stenosis, and left ventriculography showed massive MR, confirming echocardiographic finding. Evaluation by right-sided heart catheterization showed severe heart failure. Even after heart failure treatment, she had repeated chest pain and dyspnea through the night. Magnetic resonance imaging demonstrated the additional late gadolinium enhancement in the subendocardial lesion of right coronary artery (RCA) area, suggesting myocardial damage at this territory. Acetylcholine provocation test was performed to investigate the relation between coronary spasm and myocardial damage. A 50 μg acetylcholine infusion induced obstruction of the distal portion of RCA. Her chest pain accompanied by ST-T change was also appeared. We thus diagnosed coronary spasm exacerbate the tethering of posterior leaflet and worsened MR. Early mitral valve replacement was required for recovery from refractory heart failure. We herewith report that acute ischemia due to coronary spasm could be a major cause of worsening of MR in a patient with d-HCM.
Introduction: The increase in LV volume after myocardial infarction, a representational form of the remodeling process, result in severe cardiac dysfunction. LV endoventricular patch plasty is a surgical treatment to restore heart geometry and finally to improve cardiac function. Case: Five years ago, 63-year-old man developed acute broad anterior myocardial infarction (peak CPK 10188 IU/L). Although optimal medical therapy was introduced, he was repeatedly hospitalized because of heart failure. During this admission, he got dependent on catecholamine treatment. Echocardiogram showed severe left ventricular dysfunction localized in antero-septal wall with severe aortic regurgitation and mitral regurgitation. One year ago, LV endoventricular patch plasty: modified Dor, with aortic valve replacement and mitral valve plasty were performed. After the operation, LV volume reduced effectively and cardiac function improved. He could discharge to home after discontinuation of catecholamine treatment and reduction of diuretics dose. He has remained under stable conditions for this one year. Discussion: LV endoventricular patch plasty is one of the effective surgical treatments to treat severe heart failure. However, in some cases who have little residual cardiac muscle, the effectiveness cannot be expected. Moreover, LV endoventricular patch plasty has a high risk because the candidate is suffering poor conditions. Therefore, we should carefully consider the operative indication of LV endoventricular patch plasty and its limitations.
P7-2
P7-5
A Case of Hypertrophic Obstructive Cardiomyopathy and Vasospastic Angina, in Which Controlling Medical Treatment was in Great Distress Hiroki Teragawa, Yuichi Fujii, Yuko Uchimura, Tomohiro Ueda; The Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
A Case of Difficult in the Treatment of Heart Failure After Acute Myocardial Infarction of the Left Main Coronary Artery Yoji Tamaki, Yoshihiro Masaki, Taro Koya, Toshihiro Shimizu, Takayuki Hirabayashi; Cardiovascular Medicine, Sunagawa City Medical Center, Hokkaido, Japan
Vasospastic angina (VSA) is accompanied with hypertrophic obstructive cardiomyopathy (HOCM). In such patients, controlling medical treatment may be sometimes difficult, because some drugs for VSA may deteriorate the status of HOCM. We experience such case. A woman in her seventies, was admitted to our institution, because of detail examination of chest symptoms at rest. Coronary angiography showed the presence of coronary spasm. In addition, cardiac catheterization showed that the positive
A 70-year-old male had chest pain and in a shock status, was received an emergency catheterization with intra aortic balloon pumping. He had developed an acute myocardial infarction of the left main coronary artery, then percutaneous coronary intervention was done. Because infarct size were large, peak CPK was 9673 IU/L and and peak CK-MB was 690 ng/ml with high value. Congestive heart failure (CHF) was worsened after admission to intensive care unit, so mechanical ventilation was performed.